Ced305.indd

Conference Report
Report of the 17th European Stroke
Free Author
Copy - for per-
Conference, Nice, May 13–16, 2008
sonal use only
PLEASE NOTE THAT ANY
DISTRIBUTION OF THIS AR-
TICLE WITHOUT WRITTEN
CONSENT FROM S. KARGER
AG, BASEL IS A VIOLATION OF THE COPYRIGHT. Upon request a written per- Neurological Institute, Columbia University College of Physicians and Surgeons, New York, N.Y. , USA mission to distribute the PDF fi le will be granted against payment of a permission fee depending on the number of accesses required. Please contact Karger Publishers, Basel, Switzerland at [email protected] No less than 3,665 attendees from 83 countries arrived The first official day of the conference, 14 May, opened in Nice for the 17th European Stroke Conference, held at with parallel sessions held in no less than 7 rooms, on the Acropolis Palais de Congrès et des Expositions facil- acute stroke, stroke and infections, risk factors and their ity (in Nice, not Greece). This number continues the trend management, and ditto for diabetes. These sessions were of increasing attendance (an increase of almost 1,000 finished in time for general attendance at the highlights people compared to the Glasgow meeting in 2007), re- of the meeting. First, after an elegant introduction by J. flecting the high profile of the European Stroke Confer- van Gijn, M.G. Bousser, the Johann Jacob Wepfer award- ence. In fact, 165 web pages were needed to detail the ee, gave a wide-ranging presentation, citing the role in program.
research and effect of therapies for women on almost all On the first day, 13 May, a repeat of the increasingly of the subjects covered. These subjects spanned a scope popular workshops and teaching sessions were held, as of over 30 years, starting from the initial TIA trials run well as an all-day 2nd TIA Satellite Symposium, chaired by H.J.M. Barnett (including the rarely cited 1958 refer-by P. Amarenco, and featuring G. Donnan, P. Kelly, P. ence on aspirin benefit by Lawrence Craven in Missis-Sandercock, S. Coutts, M.G. Hennerici, H.-C. Diener, sippi Valley Medicine ); CADASIL was reviewed, empha-and A. Schwartz, finishing in the afternoon with P.M. sizing the thick arteries and accompanying rigidity. Two Rothwell, A. Buchan, P. Amarenco, and summarized by other subjects, hemicraniectomy and closure for patent M.G. Hennerici. The entire gamut of TIA issues was dis- foramen ovale, were given thoughtful analyses of the cussed. During the same day, the 2nd Nursing and AHP clinical outcomes. None present were in doubt as to her Day was held for stroke nurses and allied personnel. In mastery (perhaps one should say ‘mistressy’) of the sub-the side rooms, 10 individual courses were held on stroke jects covered, and she finished to thunderous applause.
in the newborn and stroke in the elderly, clinical syn- What followed was one of the highlights of the confer- dromes, poststroke complications and stroke outcome, ence, i.e. presenting latest news from large clinical trials. MRI, and even ‘How to write a good article’. That eve- Three of those were from the PRoFESS trial (Prevention ning, Jean-Louis Mas welcomed a large crowd, Program Regimen for Effectively Avoiding Second Strokes). Spon-Committee chair M.G. Hennerici, and Scientific Com- sored by Boehringer-Ingelheim and hailed as the largest mittee chair J.M. Ferro, on behalf of his French colleagues, worldwide study of secondary stroke prevention, the in the Apollo conference auditorium of the venue.
PRoFESS trial randomized over 20,000 patients from 695 Neurological Institute , Columbia University College of Physicians and Surgeons Tel. +1 212 305 8033, Fax +1 212 305 5796, E-Mail [email protected] worldwide sites who had had initial ischemic stroke for Carotid vs. Endarterectomy) study. The outcomes for the an observational period of up to 4 years. The trial com- two procedures overlapped for 2-year outcomes of mor- pared the safety and efficacy of 25 mg aspirin/200 mg tality, any stroke, and any ipsilateral stroke, but restenosis extended-release dipyridamole (Aggrenox € , Asasan- was more frequent in the stent arm.
tine € ) with clopidogrel, and of telmisartan (Micardis € ) The session ended with a report by D.F. Hanley on the with placebo, atop any ongoing therapy for hypertension. three outcomes of the CLEAR trial (clot lysis, safety, and This three-part presentation of the PRoFESS trial fea- 30-day outcome). This trial, involving r-tPA given via an tured the co-investigators R.L. Sacco, H.-C. Diener and external ventricular device, rated 6-month outcomes for S. Yusuf. Some of the results had leaked out from the in- 52 subjects admitted within 12 h of onset and receiving vestigator meeting the day before despite requests for em- r-tPA up to 60 h from onset, and showed outcomes suf- bargo, but the presentations were extremely clear: in brief ficiently encouraging as to propose a phase III clinical (and to avoid presenting any quantitative data pending trial.
publication), no difference could be found in the com- Posters were available for review during the lunch parison of low-dose aspirin and long-acting dipyridam- break on the first as well as on the second day.
ole or clopidogrel for the primary outcome of recurrent In the afternoon, there were discussions in the Apollo stroke. The risk of stroke, myocardial infarction or vas- auditorium on the implications of the current clinical tri- cular death was identical in the two treatment groups. al data by P. Gorelick, A. Algra, S. Yusuf, P. Bath, and G. The study was unable to conclude noninferiority; no in- Hankey. Later, in side rooms, acute stroke concepts, state- teraction was observed between telmisartan and placebo. of-the-art vascular biology, heart-brain/venous diseases, Major hemorrhage and headache were slightly more fre- and prognostic predictors were the subjects of presenta- quent in the low-dose aspirin and long-acting dipyri- damole arm, but the two treatments were comparable in Thursday, 15 May, featured a morning plenary session the occurrence of myocardial infarction, a comparison on the subject of stroke care in Europe. Presenters in-hitherto untested in a clinical trial. No neuroprotective cluded T. Truelsen (Denmark), T. Tsiskaridze (Georgia), effects were found over time or at the end of the trial. For D. Leys (France) and B. Norrving (Sweden). Results of a the telmisartan part of the trial, no significant differenc- random European survey showed that (1) less than 10% es were found between telmisartan and placebo in the of European hospitals admitting acute stroke patients primary outcome of recurrent stroke, or the secondary have a facility for such treatment; (2) 85% of stroke pa-outcomes of stroke, myocardial infarction, vascular tients are not treated in an appropriate unit; (3) there are death, or new or worsening of congestive heart failure. It differences between countries, and (4) r-tPA is underuti-was suggested that the effects of this angiotensin receptor blocker may be greater for those treated for more than 6 An even larger range of presentations was conducted throughout the day in side rooms. The correspondent The large clinical trial session was continued with an was unable to do more than a survey of some of these spe- update on EVA-3S (NCT00190398) presented by J.L. Mas. cific presentations, mainly due to the concurrent work- The trial had a noninferiority plan for the risk of stroke shop on the ARUBA trial. Fortunately, the main program within 30 days of the procedure, and thereafter for a long- contained detailed abstracts for these platform presenta- term follow-up. The study was balanced for age, gender, tions.
diabetes mellitus, prior stroke, prior myocardial infarc- Many were almost relieved to find the scope and num- tion, therapy with antiplatelets, antihypertensives, lipid- ber of subjects to be a bit smaller on the last day, Friday lowering agents, and nonsmokers; the distribution of le- 16 May. In the Apollo auditorium, a joint session of the sions was almost all 1 70%. Those over age 70 had more European Society of Cardiology and the European Stroke periprocedural events, but thereafter the 4-year event Conference provided presentations of stroke mecha-rates compared favorably with those after endarterecto- nisms. C. Schneider discussed the metabolic syndromes, my. Of special interest was the lower 30-day stroke rate noting that 1,500 kcal a week greatly improves prognosis. among the 39% of cases in whom stenting was performed Brisk walking 30–50 min several times per week, espe- by those in training, under supervision, compared with cially worthwhile for diabetics, as often as 3–4 h a week, those deemed experienced.
could result in a mortality risk reduction of 50%. The ses- P.A. Ringleb followed with the 2-year results of the sion ended with a summary from P. Amarenco on TIAs. SPACE (Stent-Protected Percutaneous Angioplasty of the He proposed a 1-hour definition for TIA versus stroke, and suggested a simple dichotomy based on time from da) reported on the increasingly popular search for a ‘spot the event: same day or continuing symptoms, go to a sign’. Its prediction for hematoma expansion was highest stroke unit; if the symptoms are gone, go to a TIA clinic. for those imaged in the 2-hour time frame. The popula-Moreover, he reviewed the ABCD acronym from Roth- tion-based Scottish AVM study and the Oxfordshire well, and repeated a proposal from the Round Table of the project demonstrated in both populations a large increase 1st TIA symposium in Paris 2006 that TIA should be re- in severity from primary parenchymatous brain hemor- placed by ‘acute cerebrovascular syndrome’; however, rhage versus that from arteriovenous malformation, with whether TIA can be replaced as a term remains to be no differences found for hematoma volume or ventricular seen.
Parallel presentations were conducted in 5 rooms, cov- Satellite symposia held during the conference includ- ering intracerebral and subarachnoid hemorrhages, vas- ed antiplatelet strategies, stroke registries and data banks, cular neurosurgery, etiology of stroke, meta-analyses and management of ischemic stroke (Boehringer-Ingelheim review papers, and symposia. In the hemorrhage ses- sponsor), optimized stroke care for readmission reduc- sions, Marti-Fabregas et al. (Spain) noted that neurologi- tion in Europe (BMS sponsor), stroke research priorities cal worsening correlated with hematoma enlargement. for the next decades (Ferrer Group sponsor), and even Hematoma enlargement of 1 33% was reported in almost one for Francophones (French Neurovascular Society).
half of the patients seen and imaged within 6 h of onset. The correspondent regrets being unable to survey the The clinical evidence of worsening was most often seen full range of presentations and posters, having concen-in those whose enlargement was at least 46%. Hemor- trated on those presentations in the main (Apollo) audi- rhagic features of the reversible cerebral vasoconstriction torium, most of which were not accompanied by printed syndrome (so-called Call-Fleming syndrome) were de- summaries. It is hoped those who find themselves not scribed by Ducros et al. (France). R. Brown et al. from the cited will take no offense, expecting a bigger impact when Mayo Clinic (USA) reviewed the clinical recommenda- the work appears in peer-reviewed print.
tions for aneurysm management. Demchuk et al. (Cana- Free Author
Copy - for per-
sonal use only
PLEASE NOTE THAT ANY
DISTRIBUTION OF THIS AR-
TICLE WITHOUT WRITTEN
CONSENT FROM S. KARGER
AG, BASEL IS A VIOLATION
OF THE COPYRIGHT.
Upon request a written per-
mission to distribute the PDF
fi le will be granted against
payment of a permission fee
depending on the number of
accesses required. Please
contact Karger Publishers,
Basel, Switzerland at
[email protected]

Source: http://eurostroke.org/pdf/cedi%20mohr.pdf